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Sleep Review Magazine: "More Medical Experts Weigh in on Philips Recall"

Oral appliance therapy can be a very effective treatment choice for people suffering with obstructive sleep apnea and snoring.However, not all oral appliances are the same, and FAR more important than the oral appliance itself is the experience and skill of the Dentist treating you with the oral appliance therapy. Here are 5 Questions you need to have answered BEFORE you consider starting oral appliance therapy:

A new study presented at the virtual 2021 Annual Meeting of The Association for Research in Vision and Ophthalmology (ARVO) points to the cause of high incidence of sleep disorders in patients with glaucoma. A recent study of more than 6,700 people showed that glaucoma patients have a high incidence of sleep disorders. Intrinsically photosensitive retinal ganglion cells (ipRGCs), which are involved in circadian rhythms, are also known to be injured in glaucoma. The ipRGCs provide input to the ventrolateral preoptic nucleus (VLPO), a major sleep-inducing subcortical structure. Ventrolateral preoptic nucleus induces sleep by delivering inhibitory signals to the subcortical arousal systems and the cortex. Inspired by these findings, Ji Won Bang, PhD, and her team at the New York University Grossman School of Medicine, investigated whether the sleep-regulating subcortical systems involving ventrolateral preoptic nucleus and their inhibitory projections to the cortex are impaired in glaucoma. [RELATED: Why Obstructive Sleep Apnea Patients Are Prone to Suffer from Glaucoma] The study’s 38 glaucoma patients and 22 healthy subjects underwent 3T anatomical MRI and resting-state functional MRI (fMRI) with eyes closed. Additionally, 25 glaucoma patients and 7 healthy subjects were scanned for 3T anatomical MRI and proton magnetic resonance spectroscopy (MRS). Results showed that the sleep-regulating subcortical systems involving ventrolateral preoptic nucleus and their projections to the occipital cortex are impaired under glaucoma. Such alterations may underlie the high occurrence of sleep disorders in glaucoma. As intraocular pressure is currently the only clinically modifiable risk factor for glaucoma, Bang hopes this research may lead to a better understanding of glaucoma pathogenesis in relation to sleep problems in the brain, which could contribute to better strategies to target glaucoma treatment beyond intraocular pressure control. Bang says in a release, “We expect our study will bring attention to research that investigate changes in the brain and their behavioral relevance in glaucoma. We wish our study will contribute to developing more targeted therapeutic interventions for glaucoma patients who suffer from sleep problems.” Photo 9003039 © Monkey Business Images | Dreamstime.com Posted by Sree Roy | May 4th, 2021

http://dx.doi.org/10.15331/jdsm.7166 Caetano Petrella1; Milton Maluly, PhD1; Gabriel Natan Pires, PhD1,2; Monica L. Andersen, PhD1; Sergio Tufik, MD, PhD1 1Departamento de Psicobiologia, Universidade Federal de São Paulo – São Paulo, SP, Brazil; 2Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences – São Paulo, SP, Brazil The recent article published by Schwartz et al. entitled “Oral appliance therapy should be prescribed as a first-line therapy for OSA during the COVID-19 pandemic”1 is opportune and welcome. We would like to endorse their statements and call attention to further aspects. The article adds significant information in respect of the current approach to treating obstructive sleep apnea (OSA) during the COVID-19 pandemic. This is particularly important, as we still know relatively very little about the transmission and dissemination mechanisms of COVID-19. Recent studies have suggested that there is a relationship between COVID-19 and OSA2, which reinforces the need to discuss the most suitable approach to the treatment of sleep-disordered breathing during the pandemic. The authors stated that currently the American Academy of Dental Sleep Medicine (AASDM) has recommended oral appliance therapy (OAT) as the first-line therapy for the treatment of the OSA, especially for adult patients who prefer alternative therapies to positive airway pressure (PAP). Other Sleep Medicine societies, including the Brazilian Sleep Odontology Society (ABROS), the World Sleep Society (WSS) and the American Academy of Sleep Medicine (AASM), have also released similar guidelines, at least in respect to mild cases. OAT devices have important benefits in comparison with PAP devices, including: They do not generate aerosol, which theoretically might increase the chance of infection They are easy to disinfect, and do not pose a risk of possible reinfection Their use is associated with higher compliance rates. The authors of the article highlighted the warning given by the AASM that PAP therapy has the potential to expose those who are near OSA patients to an increased risk of COVID-19, if the patients are themselves infected. Another important point to consider is that sleep medicine services were reduced by almost 80% during the first months of the COVID-19 pandemic in Europe, and many facilities may still be closed, or working under technical restrictions. This makes PAP titration in the sleep laboratory difficult, as they are often now only able to assess a limited and highly selected number of patients3. Thus, these logistical and operational issues reinforce the benefits of OAT over PAP. We, in general, support the use of OAT, not only during the COVID-19 pandemic, but also as a first-line of treatment for mild and moderate OSA4, 5. However, we stress the need to remain aware of the criteria for the proper use of OAT, taking into consideration its indications and contraindications, the patient´s individual characteristics, and the presence of comorbidities6, and ensure that the diagnosis of OSA is made by a physician who is a registered sleep-specialist7. To prioritize the use of OAT for the treatment of OSA during the COVID-19 pandemic, odontology professionals need to pay particular attention to patient protection and hygiene measures. These measures should be clearly explained to the patients in order to assure the safety of the procedures. It is of utmost importance that appropriate and comprehensive individual protection equipment (IPE) is used, and that strict hygiene measures in respect of the working environment are taken. All surfaces must be disinfected with alcohol with, at least a concentration of 62%, and 0.5% of hydrogen peroxide or 1,000 ppm (0.1%) of sodium hypochlorite8,9. In the waiting room, patients should keep a minimum distance of 1.5 meters from one another, and there should be an interval of at least 30 minutes between appointments to avoid overcrowding and allow enough time for the disinfection of the environment. If possible, there should be natural ventilation to avoid the use of air conditioning. These protection and disinfection measures, and compliance with all recommendations from sanitary authorities, can help to make the patients feel safe in their search for treatment and follow-up OAT therapy. We add our support to the recommendation given by Schwartz et al., and sleep medicine societies worldwide that OAT should be the first-line of treatment of mild and moderate OSA during the COVID-19 pandemic.

If you are having problems sleeping, the National Sleep Foundation suggests the following to improve your sleep: Set and stick to a sleep schedule. Go to bed and wake up at the same times each day. Expose yourself to bright light in the morning and avoid it at night. Exposure to bright morning light energizes us and prepares us for a productive day. Alternatively, dim your lights when it’s close to bedtime. Exercise regularly. Exercise in the morning can help you get the light exposure you need to set your biological clock. Avoid vigorous exercise close to bedtime if you are having problems sleeping. Establish a relaxing bedtime routine. Allow enough time to wind down and relax before going to bed. Create a cool, comfortable sleep environment that is free of distractions . If you’re finding that entertainment or work-related communications are creating anxiety, remove these distractions from your bedroom. Treat your bed as your sanctuary from the stresses of the day. If you find yourself still lying awake after 20 minutes or so, get up and do something relaxing in dim light until you are sleepy. Keep a “worry book” next to your bed. If you wake up because of worries, write them down with an action plan, and forget about them until morning. Avoid caffeinated beverages, chocolate and tobacco at night. Avoid large meals and beverages right before bedtime. No nightcaps. Drinking alcohol before bed can rob you of deep sleep and can cause you to wake up too early. Avoid medicines that delay or disrupt your sleep . If you have trouble sleeping, ask your doctor or pharmacist if your medications might be contributing to your sleep problem. No late-afternoon or evening naps, unless you work nights . If you must nap, keep it under 45 minutes and before 3:00 pm. While above may help. If you have Obstructive Sleep Apnea, this is not effective treatment. See Patient Info to take your next steps.

“Sleep-deprived drivers cause more than 6,400 deaths and 50,000 debilitating injuries on American roadways each year.” said Charles A. Czeisler, PhD, MD who is working with the National Sleep Foundation on its Drowsy Driving Consensus Panel. If your quality of sleep is compromised due to an issue such as obstructive sleep apnea (OSA) you are putting yourself and others at risk every time you get behind the wheel. Drowsy Driving is Dangerous! Get out of danger – see Patient Info to take your next steps!

Snoring affects approximately 90 million American adults and is a common problem among all ages and both genders. It can cause disruptions to your own sleep and your bed-partner’s sleep. It can lead to fragmented and un-refreshing sleep which translates into poor daytime function (tiredness and sleepiness). The two most common adverse health effects that are linked to snoring are daytime dysfunction and heart disease. About one-half of people who snore loudly have Obstructive Sleep Apnea. For details on how we can help you, see Patient Info.

The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness. A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene and/or need to see a sleep specialist. These issues should be discussed with your medical professional. Use the following scale to choose the most appropriate number for each situation: [CP_CALCULATED_FIELDS id=”6″] [si-contact-form form=’1′]

Has your dental office been speaking and marketing to physicians about oral appliances but receive fewer referrals than expected? One reason may be that you are not contracted as a participating provider with medical insurance. Most insurance companies have taken steps to minimize the use of out-of-network providers, including significantly higher deductibles, higher coinsurance percentages, and even Out-of-Network Consent Policies and patient notification forms. referrals-for-Dental-SleepPhysicians recognize a discord is created when their patients receive large bills because of using an out of network facility. Having marketing sleep testing services ( Millennium Sleep Lab ) to physician offices for several years, one of most common questions I get asked is, “How much will this cost my patient?”, and saying it’s covered by insurance is sufficient. Physicians understand that patients are experience rising healthcare costs and want to find a balance of quality patient care and affordability. If they know that your services will be out-of-network, they will naturally restrict referrals to only patients that have tried every other option or that they know can afford the service. As a result, you are missing out on many patient that could benefit from dental sleep therapy. Additionally, many insurance companies have an Out-of-Network Consent Policy that requires the referring physician to advise the member that he or she will be paying out-of-network cost sharing amounts and will pay much higher amount than if they were to go to an in network provider. For some plans, an Out-of-Network Consent form must be signed by the patient that emphasizes the patient will have far greater financial liability when using a non-participating (non-par) provider. This process is time consuming for the physician staff, because of the added documentation and the time explaining and discussing options with the patient. Some insurer’s administrative policies state that “whenever possible” a participating (par) provider must refer to other par providers (both professionals and facilities), and in recent years, have even started sending letters threatening that if the physician does not discontinue referring patients to out-of-network providers and start referring their patients to in-network providers, they would be terminated from the insurers’ network. This creates a dilemma for the physician knowing many of his or her patients do not have out-of-network benefits, and a high percentage of those that do will have a high deductible or will not sign the consent form. Sleep Impressions has a solution. As an in-network provider with most major insurance plans, we can alleviate the roadblocks you are facing when marketing your services to physician offices. Not only will you receive more referrals, you will also see an increase of patients going through with oral appliance therapy by minimizing out of pocket costs.